Medical Billing Services, Business and Process

305

What is Medical Billing Service or Business? 

Medical Billing Service includes submitting a claim and following up on it as a means of payment for services, a healthcare provider provide, is referred to as Medical insurance billing. Once a person forwards a claim in response to medical services, medical billers in healthcare facilities follow it up to receive remittance.  

What is the Medical Insurance Billing Process?

The medical insurance billing process may sound overly complicated but it constitutes eight simple steps. These steps include:

Patient Registration

Patient registration is the initial stage in medical insurance billing. The registration procedure begins when a patient calls a healthcare practitioner to schedule an appointment. If the patient is new, the practitioner records basic demographic information such as name, birth date, likely reason for the visit, and insurance information. The insurance policy type, the provider’s name, and the patient’s policy number are all examples of insurance information. Medical billers verify this information, creating a file in the patient’s name. If a patient visits a specific healthcare facility frequently, this process doesn’t repeat.

Confirmation of Financial Responsibility

Confirmation of Financial Responsibility is a crucial step in the medical billing process. It involves verifying that the patient or the patient’s insurance will cover the cost of the medical treatment or services being provided. The confirmation process includes a variety of methods, such as obtaining insurance information, checking the patient’s eligibility for coverage, and obtaining pre-authorization for certain procedures. Confirmation of Financial Responsibility helps to ensure that the medical provider will be paid for their services, and it also helps the patient understand their financial obligations before treatment.

Overview of Patient Check-In and Check Out

Keeping track of patient check-in and check-out is a simple and basic practice involving having the patient fill out a few documents upon arrival. Patients who visit a healthcare provider for the first time may be required to complete a few additional forms and review the medical practitioner’s information on their file to detect any inaccuracies. During security checks, patients must also provide their insurance card and formal identification, such as a driver’s license or passport. When a patient checks out, a medical coder receives their medical report and converts it into usable medical codes. A “superbill” is a complete report that includes a patient’s medical history, information on the supply of medical services, information about the medical provider, and demographic information about the patient. It is required for the following stage when filing a medical insurance claim that gets transferred to a medical biller via software. 

Monitoring Coding and Billing Compliance

A medical biller will next enter the superbill into medical billing software or a paper claim form. A biller also analyses the codes created by a coder to confirm that the claims are compliant. The Health Insurance Portability and Accountability Act (HIPAA) and the Office of the Inspector General usually adhere to guidelines.

Preparation and Transfer of Claims

Submission of HIPAA-registered standard transaction claims electronically. Although manual claims are achievable, there are numerous disadvantages to this medical insurance billing cycle method. Claims can also be routed through a third-party healthcare provider for increased efficiency and task management.

Process of Payer Adjudication

Payer adjudication is the procedure by which a payer assesses the validity of a medical claim and either accepts, rejects (if there are any errors), or refuses the claim (in case a medical facility not provided in the insurance is accounted for in the bill). This is done following the rules and regulations agreed upon by the patient and the payer. Healthcare facilities must initially generate clean claims to avoid issues later in the process.

Generation of Patient Bills and Statements 

The biller receives a report and creates a statement for the patient after a claim is accepted. The payer pays the agreed-upon sum, with the remainder going to the patient.

Consistent medical billing services are highly beneficial to healthcare facilities and medical groups. Many prominent medical billing firms provide well-planned medical coding and billing services across the United States to assist medical facilities in claiming timely reimbursements and maximizing their revenue. This article discusses the primary services provided by a reputable medical billing company.

Comprehensive Medical Billing Solutions

Medical companies must manage their revenue cycle properly by submitting medical bills and insurance claims without errors within the time restriction specified. Any coding errors or processing defects in claims and bills can be costly and result in claim denial or rejection. Medical practices and practitioners would benefit significantly from outsourcing medical coding and billing responsibilities to competent companies. These firms efficiently manage each part of the billing, coding, and processing procedures and assist in the timely submission of error-free bills and claims. An experienced medical billing company will provide the following medical billing services:

Enrollment in the billing system:

Complete patient information must be submitted when claiming payment. As a result, most businesses prioritize patient enrollment. They electronically enroll patient information from a hospital registration system, including basic information like:

• Demographic information 

• Insurance information

Insurance Verification:

The most crucial aspect of the medical billing procedure is verifying the patient’s status and insurance benefits. Professional billing companies efficiently manage the verification procedures and verify patients’ active medical coverage with the insurance company, type of plan, policy status, plan exclusions, claims mailing address, patient responsibilities, co-pays, co-insurance, deductibles, effective date, and much more.

Authorization:

It takes time to obtain insurance authorization. A reputable medical billing business performs this process. A corporation would contact the insurance company and obtain assurances that the insurer would pay for the services. You can prevent claim cancellations and maintain maximum cash flow.

Coding:

Reliable companies perform medical coding operations with accuracy and clarity. They manage medical coding audits, CPT coding, DRG/ICD-9-CM coding validations, and other related operations with exceptional accuracy to ensure maximum reimbursement.

Billing and reconciling of accounts:

Providers of professional medical billing services focus on all phases, such as collecting monthly bills, calculating self-accounting totals, handling transfer of funds, and more to ensure maximum revenue for healthcare practices. The major areas covered are:

Record invoices

Cash posting

Reconciliation

Accounts receivable collections:

Medical billing firms offer quality AR collection solutions to help medical facilities do away with credit and collection issues. These firms ensure professional solutions for:

Insurance collection

Patient collection

AR follow-up and collections

Audit:

Most companies audit the charges that the charge team enters, to evaluate the accuracy of keying and ensure that they follow the correct billing rules. They also verify the accuracy of the claims based on carrier requirements.

Accurate Billing and Coding Services

To deliver quality medical billing and coding services, most companies has experienced billing specialists staff, AAPC-certified coders, accountants and other supporting personnel. Utilizing advanced billing software and technology, they perform every phase of the billing procedures accurately, strictly following the latest medical reimbursement rules.

Final Step:

The final step in medical insurance billing ensures the accuracy of assigning patient bills and payments. Billers monitor and record all payments made by a patient. If there is delay in payment, the biller will be responsible for the reimbursement of a healthcare provider by sending follow-up bills, contacting patients directly, or even enlisting a collection agency. 

Conclusion

After reading this article, you now have a clear idea of what Medical billing services do.  For more details on how to start your own billing company, follow Teksoft blogs.

Teksoft provides the best medical billing services to improve your cashflows. Let your problem be ours. How to start a medical billing service is a question that answer we will give you in our upcoming blogs.

Also Read:

Careers in Medical Billing

Let’s get into the difference and competitive advantage between Full truckload and LTL (Less-than-truckload)